Provider Demographics
NPI:1174719694
Name:GOMEZ AMALBERT, NICOLAS (MD)
Entity type:Individual
Prefix:DR
First Name:NICOLAS
Middle Name:
Last Name:GOMEZ AMALBERT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 PASEO DE LA COSTA
Mailing Address - Street 2:
Mailing Address - City:CEIBA
Mailing Address - State:PR
Mailing Address - Zip Code:00735-3627
Mailing Address - Country:US
Mailing Address - Phone:787-556-8904
Mailing Address - Fax:
Practice Address - Street 1:24 PASEO DE LA COSTA
Practice Address - Street 2:
Practice Address - City:CEIBA
Practice Address - State:PR
Practice Address - Zip Code:00735-3627
Practice Address - Country:US
Practice Address - Phone:787-556-8904
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-18
Last Update Date:2007-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR16876208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice